Esôfago de Barrett: o estado da arte / Barrett's Esophagus: the state of the art

Objetivo: Demonstrar fatores envolvidos nos distúrbios do sono em profissionais que fazem plantões. Métodos: Trata-se de estudo transversal, cuja amostra foi composta de 244 voluntários, plantonistas da área da saúde, sendo 191 do sexo feminino, que responderam a um questionário socioeconômico, associado à aplicação da Escala de Sonolência de Epworth e ao Índice de Qualidade do Sono de Pittsburgh. Os dados foram analisados pelos coeficientes de Spearman e de Kendall Tau, com distribuição de probabilidade gama. Resultados: Houve significância (p<0,05) com o Índice de Qualidade do Sono de Pittsburgh e a atividade física (+0,216), ergonomia (+0,148), filhos (-0,146), valor da remuneração (+0,112) e disfunção durante o dia (+0,352). Também houve significância com a Escala de Sonolência de Epworth e atividade física (+0,138), renda familiar (-0,118), trabalho semanal (-0,151), latência do sono (-0,106), duração do sono (-0,107), eficiência do sono (-0,139) e disfunção durante o dia (+0,170). Por fim, a eficiência do sono teve significiância com profissão (-0,209), tabagismo (+0,402), Escala de Sonolência de Epworth (-0,139) e dissonias com a obesidade (índice de massa corporal >30; razão de chance de 1,40; intervalo de confiança de 95% de 1,02-1,94). Conclusão: As medidas autorrelatadas são prontamente obtidas com questionários validados, como a Escala de Sonolência de Epworth e o Índice de Qualidade do Sono de Pittsburgh, encontrando-se correlações com renda familiar, ter ou não filhos, índice de massa corporal, atividade física, ergonomia, condições de trabalho, tabagismo e componentes biopsicossociais. Em virtude do caráter transversal deste estudo é indispensável mais estudos com maior follow-up

Objective: To demonstrate factors involved in sleep disorders in professionals who take shifts. Methods: This is a cross-sectional study whose sample consists of 244 volunteers, on-duty health workers, 191 females, who answered a socioeconomic questionnaire, associated with application of the Epworth Sleepiness Scale and the Pittsburgh Sleep Quality Index. Data were analyzed with Spearman's and Kendall Tau coefficients, and gamma probability distribution. Results: There was significance (p<0,05) with the Pittsburgh Sleep Quality Index and physical activity (+0,216), ergonomics (+0,148), children (-0,146), the wage (+0,112), dysfunction during the day (+0,352). Also there was significance with the Epworth Sleepiness Scale and physical activity (+0,138), family income (-0,118), weekly workload (-0,151), sleep latency (-0,106), sleep duration (-0,107), sleep efficiency (-0,139), and dysfunction during the day (+0,170). Finally, sleep efficiency was significant with occupation (-0,209), smoking habits (+0,402), Epworth Sleepiness Scale (-0,139), dyssomnia with obesity (body index mass >30; OR of 1,40; CI 95% 1,02-1,94). Conclusion: Self-reported measures are readily obtained with validated questionnaires such as Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index, with correlations with family income, having children or not, body mass index, physical activity, ergonomics, working conditions, smoking habits, and biopsychosocial components. Due to the cross-sectional nature of this study, further research with longer follow-up is indispensable

Human papillomavirus and risk factors for cervical adenocarcinoma in the state of Pernambuco, Brazil / Papilomavírus humano e fatores de risco para adenocarcinoma cervical no estado de Pernambuco, Brasil

Abstract Objectives: to determine the incidence of the main high oncogenic risk types of the human papillomavirus (HPV) ( 16, 18, 31 and 33) and the risk factors for cervical adenocarcinoma. Methods: a case-control study was carried out with 324 women (69 with adenocarcinoma and 260 healthy controls) between 2001 and 2014. Information on risk factors associated with adenocarcinomawere collected and the detection performed on HPVby using Polymerase Chain Reaction (PCR) method. Results: adenocarcinoma was associated with age ≥40 years old (OR=2.95; 95%CI=1.13-7.71), ≤3 years of schooling (OR=2.34; 95%CI=1.02-5.37), presence of HPV (OR=6.75; 95%CI=2.41-18.91),women in menopausal status (OR=4.76; 95%CI:1.70-13.31) black race (OR=6.71; 95%CI= 2.11-21.32) and never had undergone cervical cancer screening (OR=9.92; 95%CI:2.41-40.81). Andamong the HPV types detected, HPV 18 was observed to be strongly associated with adenocarcinoma of the cervix (OR=99.1; 95%CI=12.96-757.78). Conclusions: the factors associated with cervical adenocarcinoma were ≥40 years old, ≤3 years of schooling, black race, menopausal status, never had undergone cervical cancer screening and the presence of HPV.

Resumo Objetivos: determinar a incidência dos principais Papilomavirus Humano (HPV) de alto risco oncogênico (16, 18, 31 e 33) e os fatores associados ao adenocarcinoma do colo uterino. Métodos: realizado estudo de caso-controle com 324 mulheres (69 com adenocarcinoma e 260 controles saudáveis), de 2001 a 2014. Foram colhidas informações sobre fatores de risco associados ao adenocarcinoma e realizada a detecção do HPV pelo método da Reação em Cadeia da Polimerase (PCR). Resultados: o adenocarcinoma foi associado à idade >40 anos (OR=2,95; IC95%=1,13 - 7,71), escolaridade <3 anos (OR=2,34; IC95%=1,02 - 5,37), presença do HPV (OR=6,75; IC95%=2,41 - 18,91), mulher no estado menopausal (OR=4,76; IC 95%=1,70 - 13,31), raça negra (OR=6,71; IC95%=2,11 - 21,32) e nunca ter feito o exame de prevenção de Papanicolau (OR=9,92; IC95%=2,41 - 40,81). Entre os tipos de HPV encontrados observou-se que HPV 18 teve forte associação (OR=99,1; IC95%=12,96 - 757,78) com o adenocarcinoma de colo uterino. Conclusões: os fatores associados ao adenocarcinoma de colo uterino foram idade >40 anos, escolaridade <3 anos, raça negra, estado menopausal, nunca ter realizado o Papanicolau e presença do HPV.

Análisis epidemiológico de cáncer de vesícula / Epidemiologic analysis of gallbladder cancer

Antecedentes: El cáncer de vesícula biliar se caracteriza por ser un tumor de mal pronóstico y diagnóstico tardío. Objetivo: Describir variables epidemiológicas del cáncer de vesícula en nuestro centro y compararlos con la bibliografía internacional. Material y métodos: En pacientes sometidos a colecistectomía entre el 1º de enero de 2006 y el 31 de diciembre de 2015, se estudiaron las siguientes variables: sexo, edad, relación mujer/varón, causa de colecistectomía, clasificación en urgencias y programadas; en los casos de cáncer de vesícula: sexo, edad, histopatología, diferenciación celular, invasión (de pared vesicular, angiolinfática, del ganglio cístico, tejidos vecinos y del hígado), estadificación (clasificaciones de Nevin y de Unión Internacional Contra el Cáncer-UICC). Resultados: Se diagnosticaron 92 neoplasias vesiculares (1,26% de todas las colecistectomías). El promedio de edad para cáncer de vesícula fue 57,9 años (rango 22-88); sexo femenino 64 (69,5%, con relación mujer/varón 2:1. La histopatología mostró 86 (93,4%) adenocarcinomas, 4 (4,4%) carcinomas escamosos y 2 (2,2%) indiferenciados con elementos de origen mesenquimático y epitelial de vesícula. Las lesiones asociadas fueron adenocarcinoma con metaplasia escamosa, 2 casos; mucosecretante, 2 casos; papilar, 1 caso; metaplasia intestinal y antral, 1 caso. En 60 (65,4%) casos fueron moderadamente diferenciados; bien diferenciados, 12 (13%); pobremente diferenciados, 11 (11,9%) e indiferenciados, 4 (4,3%). En 5 casos (5,4%), no se especificaba la diferenciación celular. Conclusión: El cáncer de vesícula diagnosticado luego de una colecistectomía es más frecuente en mujeres, con tipo histológico adenocarcinoma, llamando la atención la cantidad de pacientes jóvenes diagnosticados.

Background: Gallbladder cancer is characterized by poor prognosis and late diagnosis. Objective: The aim of our study is to describe the epidemiological variables of gallbladder cancer at our centre and to compare them with data from the worldwide literature. Material and methods: Patients undergoing cholecystectomy between January 1, 2006, and December 31, 2015. The following variables were analyzed: sex, age, male to female ratio, reason for cholecystectomy, urgent or scheduled. In case of gallbladder cancer, sex, age, histopathology, cell differentiation, gallbladder layer invasion, lymphovascular, cystic lymph node, adjacent tissues and liver invasion; and cancer staging according to Nevin staging system and the Union for International Cancer Control (UICC). Results: Ninety-two gallbladder neoplasms were found, representing 1.26% of all cholecystectomies. Mean age of patients with gallbladder cancer was 57.9 years (range, 22-88 years) of whom 69.5% (n=64) were women, with the same female to men ratio of 2:1 described for cholecystectomy. The histopathology of the 92 gallbladder cancers corresponded to adenocarcinoma, 93.4% (n= 86); squamous cell carcinoma, 4.4% (n= 4); and undifferentiated malignancy with elements of epithelial and mesenchymal origin, 2.2% (n= 2). There were two cases of adenocarcinoma with squamous metaplasia, two mucinous carcinomas, one papillary adenocarcinoma and one case of antral-type and intestinal metaplasia. Sixty tumors (65.4%) were moderately differentiated; 12 (13%) well differentiated; 11 (11.9%) poorly differentiated; and 4 (4.3%) were undifferentiated. In 5 cases (5.4%) the type of differentiation was not described. Conclusion: In gallbladder cancer diagnosed after a cholecystectomy, it is more frequent in the female sex, with adenocarcinoma being the most common histological type. Interestingly, the number of young patients with gallbladder cancer is noteworthy.

Padrão histopatológico e incidência de carcinomatose peritoneal ao diagnóstico em mulheres com câncer de ovário / Histopathological pattern and incidence of peritoneal carcinomatosis at diagnosis in women with ovarian cancer

Objetivo: Descrever o padrão histopatológico e identificar a incidência de carcinomatose peritoneal no momento do diagnóstico de mulheres diagnosticadas com neoplasia de ovário. Métodos: Trata-se de um estudo transversal e descritivo, baseado na análise secundária de dados correspondentes aos prontuários de mulheres adultas com diagnóstico de neoplasia de ovário de um serviço de referência em oncologia clínica. Foram analisados 40 prontuários entre janeiro de 2007 e janeiro de 2017. Resultados: Ao estadiamento segundo o sistema da International Federation of Gynecology and Obstetrics, três mulheres (7,5%) apresentavam estadiamento clínico (EC) II, três (77,5%) estágio ECIII com carcinomatose peritoneal/invasão da pelve e seis (15%) estágio ECIV com metástases à distância, especialmente para pulmão e fígado. Em relação ao padrão histopatológico, 20 mulheres apresentaram adenocarcinoma seroso papilífero de alto grau (50%), 4 (10%) adenocarcinoma seroso papilífero de baixo grau, 3 (7,5%) adenocarcinoma endometrioide, 3 (7,5%) tumor de teca/granulosa, 3 (7,5%) carcinoma de células claras, 3 (7,5%) tumores não classificados, 2 (5%) disgerminoma e 2 (5%) com cistoadenocarcinoma mucinosos. Conclusão: É nítida a necessidade de mais estudos envolvendo essa patologia, de modo a favorecer o diagnóstico e a intervenção em estágios mais precoces e reduzir desfechos desfavoráveis. (AU)

Objective: To describe the histopathological pattern, and to identify the incidence of peritoneal carcinomatosis at the time of the diagnosis of women diagnosed with ovarian neoplasm. Methods: This is a cross-sectional and descriptive study, based on the secondary analysis of data corresponding to the medical records of adult women diagnosed with ovarian neoplasm in a reference service of clinical oncology. A total of 40 medical records were analyzed between January 2007 and January 2017. Results: At the staging (FIGO system) of the International Federation of Gynecology and Obstetrics, three women (7.5%) had clinical staging (EC) II staging, 31 (77.5%) were in the ECIII stage, with peritoneal carcinomatosis/pelvic invasion, six (15%) were in the ECIV stage, with metastases at a distance, especially to lung and liver. Regarding the histopathological pattern, twenty women had high-grade papillary serous adenocarcinoma (50%), 4 (10%) with low-grade papillary serous adenocarcinoma, 3 (7.5%) with endometrioid adenocarcinoma, 3 (7.5%) with granulosa-theca tumor, 3 (7.5%) with clear cell carcinoma, 3 (7.5%) with unclassified tumors, 2 (5%) with dysgerminoma, two (5%) with mucinous cystadenocarcinoma. Conclusions: There is a clear need for further studies involving this pathology, in order to favor diagnosis and intervention at earlier stages and to reduce unfavorable outcomes. (AU)

Perfil de pacientes diagnosticados com câncer de vesícula biliar / Profile of patients diagnosed with gallbladder cancer

Objetivo: Descrever o perfil clínico-epidemiológico de pacientes diagnosticados com câncer de vesícula e identificar o estadiamento do tumor estabelecido no momento do diagnóstico, bem como o padrão histopatológico no momento da biópsia. Métodos: Trata-se de estudo transversal e descritivo realizado em um serviço de referência em oncologia clínica, baseado em análise secundária de dados correspondentes aos prontuários de indivíduos com diagnóstico de câncer de vesícula biliar atendidos entre janeiro de 2007 e janeiro de 2017. Resultados: A distribuição por sexo foi de cinco mulheres (62,5%) e três homens (37,5%). A idade variou de 47 a 74 anos, com média de 61,1 anos e desvio padrão de ±9,03. Nenhum indivíduo era assintomático ao diagnóstico; seis (75%) apresentaram dor em hipocôndrio direito, dois (25%) perda de peso e dois outros (25%) massa palpável. Dos oito indivíduos, seis (75%) apresentavam estadiamento clínico (EC) IV ao diagnóstico. O perfil histopatológico apresentou 100% de adenocarcinoma, sendo uma amostra com áreas papilíferas, três moderadamente diferenciadas, três metastáticas e uma bem diferenciada. Conclusão: O perfil clínico-epidemiológico estabelecido foi maior prevalência de câncer de vesícula biliar em mulheres, com média de idade na sétima década. Predominou a cólica biliar como sintoma. O padrão de adenocarcinoma foi identificado em todos os indivíduos. Três quartos dos indivíduos apresentavam estágio avançado de doença. (AU)

Objective: to describe the clinical-epidemiological profile of patients diagnosed with gallbladder cancer, and to identify tumor staging established at the time of diagnosis, as well as the histopathological pattern at the biopsy. Methods: This is a cross-sectional and descriptive study, carried out in a reference service of clinical oncology, based on secondary analysis of data corresponding to the medical records of patients diagnosed with Gallbladder cancer seen between January-2007 and January-2017. Results: Gender distribution was of five women (62.5%), and three men (37.5%). Patients' ages ranged from 47-74 years, mean age of 61.1 years and standard deviation of ±9.03). No patient was asymptomatic at diagnosis, six (75%) had right hypochondrium pain, two (25%) showed weight loss, and two others (25%), palpable mass. Of the eight patients, six (75%) had EC IV staging at diagnosis. The histopathological profile showed 100% of adenocarcinoma, with one sample having papilliferous areas, three being moderately differentiated, three metastatic, and one well differentiated. Conclusion: The clinical-epidemiological profile established in this study had a higher prevalence of gallbladder cancer in women, with a mean age of the individual around the 7th decade. The most frequent symptom was biliary colic. The adenocarcinoma pattern was identified in all individuals. Three-quarters of them had advanced disease. (AU)

Characterization of women with cervical cancer assisted at Inca by histological type / Caracterização de mulheres com câncer cervical atendidas no Inca por tipo histológico

ABSTRACT OBJECTIVE To determine the distribution of sociodemographic, reproductive, clinical and lifestyle habits in the cohort of women diagnosed with cervical cancer, assisted at Inca between 2012 and 2014, according to the histological type. METHODS Retrospective observational study of a hospital cohort of 1,004 women diagnosed with cervical cancer. Data were obtained from the Inca hospital cancer registry, physical and electronic records. RESULTS The most frequent histological type was squamous cell carcinoma (83.9%). Approximately 70% of the women aged more than 40 years. The study includes non-white women (67.4%), with less than 8 years of education (51.9%), with onset of sexual activity up to 16 years of age (40.7%), who were pregnant before (95.5%), with more than one pregnancy (82.9%), and more than two children (52.7%); 45.8% of the women were smokers or former smokers. Cervical adenocarcinoma was positively associated with earlier staging (IA-IIA) (OR = 1.79; 95%CI 1.03-3.13), as well as women with ≥ 12 years of education (OR = 6.30; 95%CI 1.97-20,13), who had no children (OR = 3.81; 95%CI 1.20 - 12,08) or who had up to two children (OR = 1.74; 95%CI 1.05 - 2,87). CONCLUSIONS The difference between histological types is highlighted, suggesting that women with cervical adenocarcinoma may represent a distinct clinical entity of cervical neoplasia, which may require different approaches from those used in squamous cell carcinoma.

RESUMO OBJETIVO Determinar a distribuição das características sociodemográficas, reprodutivas, clínicas e de hábitos de vida na coorte de mulheres diagnosticadas com câncer cervical, atendidas no Inca entre 2012 e 2014, segundo o tipo histológico. MÉTODOS Estudo observacional retrospectivo de uma coorte hospitalar de 1.004 mulheres diagnosticadas com câncer cervical. Os dados foram obtidos pelo Registro Hospitalar de Câncer do Inca, prontuários físicos e eletrônicos. RESULTADOS O tipo histológico mais frequente foi o carcinoma de células escamosas (83,9%). Aproximadamente 70% das mulheres foram diagnosticadas com mais de 40 anos de idade. Houve a predominância de mulheres não brancas (67,4%), com menos de 8 anos de escolaridade (51,9%), com início da atividade sexual até 16 anos de idade (40,7%), que já engravidaram alguma vez na vida (95,5%), com mais de uma gestação (82,9%) e mais de dois filhos (52,7%); 45,8% das mulheres eram tabagistas ou ex-tabagistas. O adenocarcinoma cervical esteve positivamente associado ao estadiamento mais precoce (IA-IIA) (OR = 1,79; IC95% 1,03-3,13), assim como a mulheres com ≥ 12 anos de estudo (OR = 6,30; IC95% 1,97-20,13), que não tiveram filhos (OR = 3,81; IC95% 1,20-12,08) ou que tiveram até dois filhos (OR = 1,74; IC95% 1,05-2,87). CONCLUSÕES Destaca-se a diferença entre os tipos histológicos, sugerindo que as mulheres com adenocarcinoma cervical possam representar uma entidade clínica distinta de neoplasia cervical, podendo demandar abordagens diferentes das utilizadas no carcinoma de células escamosas.

Hiperplasia prostática gigante. Adenocarcinoma. Reporte de un caso / Giant prostatic hyperplasia. Adenocarcinoma. Case report

RESUMEN Se presenta el caso de una hiperplasia prostática gigante, combinada con un adenocarcinoma que se presentó como una tumoración abdominal. El paciente presentaba una tumoración palpable en hipogastrio y un síndrome obstructivo urinario bajo. Se intervino quirúrgicamente y se realizó adenomectomía combinada, transvesical y retropúbica. La biopsia informó pequeño adenocarcinoma prostático acinar Gleason 3-4 puntos, en el contexto de una hiperplasia prostática. El paciente evolucionó satisfactoriamente y se sigue en consulta. La tumoración extraída tenía 736 g y constituye la de mayor peso reportada en Cuba y la quinta a nivel mundial (AU).

ABSTRACT We describe the case of a giant prostatic hyperplasia, combined with an adenocarcinoma presented as an abdominal tumor. The patient had a palpable tumor in the hypogastrium and a low urinary obstructive syndrome. He was operated and a combined, transvesicular and retropubic adenomectomy was performed. The biopsy informed a little 3-4 points-Gleason, acinar, prostatic adenocarcinoma, in the context of a prostatic hyperplasia. The patient evolved satisfactorily and was followed up in consultation. The removed tumor was 736 g, and is the heaviest one reported in Cuba and the fifth worldwide (AU).

Epidemiology and survival of colon cancer among Egyptians: a retrospective study / Epidemiologia e sobrevida para o câncer de cólon entre egípcios: estudo retrospectivo

ABSTRACT Introduction: Colorectal cancer is the 4th commonest cancer in the world. Studies had shown different tumor behavior depending on the site, pathology and stage. However the characters of Egyptian colon cancer patients are not well addressed. Method: Computerized registry of a tertiary cancer hospital in Egypt was searched for colon cancer cases. Demographic, pathologic and treatment data were collected and analyzed using SPSS program. Results: About 360 colon cancer patients attended our center in the last 12 years. Tumor characters showed great diverse from that of developed countries, with especially different prognosis and survival. Conclusion: Egyptians have unique tumor characters and behavior, and different compliance with treatment regimens. Multicenter prospective studies, as well as evolving Egyptian treatment guidelines are needed to address this.

RESUMO Introdução: Câncer colorretal é a quarta neoplasia mais comum a nível mundial. Estudos demonstraram diferentes comportamentos do tumor, dependendo do local, da patologia e do estágio. Contudo, ainda não estão devidamente definidas as características dos pacientes egípcios com câncer de cólon. Métodos: Foi realizada pesquisa no registro computadorizado de um hospital terciário para pacientes com câncer, à busca de casos de câncer de cólon. Foi feita coleta de dados demográficos, patológicos e terapêuticos. Tais dados foram então submetidos à análise com o programa SPSS. Resultados: Nos últimos 12 anos, cerca de 360 pacientes portadores de câncer de cólon foram atendidos em nosso Centro. As características dos tumores demonstraram grandes diferenças em comparação com os achados de países desenvolvidos e, em especial, com relação ao prognóstico e à sobrevida. Conclusão: Os egípcios exibem características e comportamentos singulares com relação aos tumores, além de diferentes graus de cooperação com os regimes terapêuticos. Para que tais aspectos sejam sanados, há necessidade de mais estudos prospectivos multicêntricos, bem como de um aprimoramento das diretrizes terapêuticas para os egípcios.

Frecuencia y características del cáncer de vesícula biliar en un hospital de referencia al sur del Perú, 2009-2014: estudio descriptivo / Frequency and characteristics of gallbladder cancer at a referral hospital in southern Peru, 2009-2014: a descriptive study

INTRODUCCIÓN: El cáncer de vesícula biliar es una neoplasia poco común, y su frecuencia es variable en las regiones de Perú. OBJETIVO: Determinar la frecuencia y describir las características clínicas del cáncer de vesícula biliar en un hospital de referencia al sur de Perú. MÉTODOS: Estudiamos los informes de todas las muestras de colecistectomías realizadas entre los años 2009 y 2014, en el servicio de anatomía patológica del Hospital Regional Honorio Delgado. Además, revisamos las historias clínicas de los pacientes que tuvieran algún resultado compatible con cáncer de vesícula biliar. RESULTADOS: De 2991 colecistectomías, 75 (2,5%) tuvieron cáncer de vesícula biliar. El síntoma más frecuente en ambos grupos fue el dolor (96,7%), seguido de náusea (87,5%) y vómitos (65,0%). La mayoría de pacientes fueron mujeres (83,3%) mayores de 60 años (65,0%). El tipo histológico más frecuente fue el adenocarcinoma (80,0%). CONCLUSIÓN: La frecuencia de cáncer de vesícula biliar en un hospital de referencia del sur de Perú, es de 2,5% mayor a la reportada en otros estudios en las regiones centro y norte del país.

INTRODUCTION: Gallbladder cancer is a rare neoplasm, its frequency is variable in the regions of Peru. OBJECTIVE: To determine the frequency and describe the clinical characteristics of gallbladder cancer in southern Peru. METHODS: The reports of the anatomopathological department of the Honorio Delgado Regional Hospital were selected from all samples of cholecystectomies performed between 2009 and 2014 and those that had some result compatible with gallbladder cancer were looked for. Subsequently, the clinical histories were searched to obtain the characteristics of these patients. RESULTS: Of 2991 cholecystectomies, 75 (2.5%) had gall bladder cancer. The most frequent symptom in both groups was pain (96.7%), followed by nausea (87.5%) and vomiting (65.0%). The majority of patients were women (83.3%) older than 60 years (65.0%). The most frequent histological type was the adenocarcinoma (80.0%). CONCLUSION: The frequency of gallbladder cancer in a reference hospital in southern Peru is 2.51%, higher than that reported in other studies in the central and northern regions of Peru.

Lung cancer: changes in histology, gender, and age over the last 30 years in Brazil / Câncer de pulmão: mudanças na histologia, sexo e idade nos últimos 30 anos no Brasil

ABSTRACT Objective: To describe the trends in tumor histology, gender and age among patients with non-small cell lung cancer (NSCLC) treated with lung resection. The histology of lung cancer has changed in developed countries, and there is still little information available on the topic for developing countries. Methods: This was a retrospective study of 1,030 patients with NSCLC treated with lung resection between 1986 and 2015 at a university hospital in southern Brazil. Differences in histology, stage, and type of surgery were analyzed by gender and for three periods (1986-1995, 1996-2005, and 2006-2015). Results: Most (64.5%) of the patients were males, and the main histological types were squamous cell carcinoma (in 40.6%) and adenocarcinoma (in 44.5%). The mean age at surgery during the first period was 56.4 years for women and 58.9 years for men, compared with 62.2 for women and 64.6 for men in the third period (p < 0.001). The proportion of females increased from 26.6% in the first period to 44.1% in the third. From the first to the third period, the proportion of patients with squamous cell carcinoma decreased from 49.6% to 34.8% overall (p < 0.001), decreasing to an even greater degree (from 38.9% to 23.2%) among men. Among the NSCLC patients in our sample, females with adenocarcinoma accounted for 11.9% in the first period and 24.0% in the third period (p < 0.001). Conclusions: As has been seen in developed countries, the rates of lung cancer in females in southern Brazil have been rising over the last three decades, although they have yet to surpass those observed for males in the region. The incidence of squamous cell carcinoma has decreased in males, approaching adenocarcinoma rates, whereas adenocarcinoma has significantly increased among women.

RESUMO Objetivo: Descrever as tendências da histologia do tumor, do gênero e da idade em pacientes com câncer de pulmão de células não pequenas (CPCNP) tratados com ressecção pulmonar. A histologia do câncer de pulmão mudou em países desenvolvidos, e ainda há pouca informação disponível sobre o tema em países em desenvolvimento. Métodos: Estudo retrospectivo com 1.030 pacientes com CPCNP tratados através de ressecção pulmonar entre 1986 e 2015 em um hospital universitário no sul do Brasil. As diferenças em histologia, estádio e tipo de cirurgia foram analisadas por gênero e em três períodos (1986-1995, 1996-2005 e 2006-2015). Resultados: A maioria dos pacientes (64,5%) era do sexo masculino, e os principais tipos histológicos foram carcinoma de células escamosas (40,6%) e adenocarcinoma (44,5%). A média de idade à cirurgia durante o primeiro período foi de 56,4 anos para mulheres e de 58,9 anos para homens, enquanto essa foi de 62,2 para mulheres e 64,6 para homens no terceiro período (p < 0,001). A proporção de mulheres aumentou de 26,6% no primeiro período para 44,1% no terceiro. Do primeiro ao terceiro período, a proporção de pacientes com carcinoma de células escamosas diminuiu de 49,6% para 34,8% no total (p < 0,001), diminuindo para um grau ainda maior (de 38,9% para 23,2%) entre os homens. Entre os pacientes com CPCNP em nossa amostra, mulheres com adenocarcinoma representaram 11,9% no primeiro período e 24,0% no terceiro período (p < 0,001). Conclusões: Como se observa em países desenvolvidos, as taxas de câncer de pulmão em mulheres no sul do Brasil têm aumentado nas últimas três décadas, embora ainda não tenham superado as observadas em homens na região. Entre homens no sul do Brasil, a incidência de carcinoma de células escamosas diminuiu, aproximando-se a de adenocarcinoma. A incidência de adenocarcinoma entre mulheres no sul do Brasil aumentou significativamente.

Características endoscópicas y patológicas del cáncer gástrico en un hospital público peruano / Endoscopic and pathological characteristics of gastric cancer in a Peruvian public hospital

RESUMEN Objetivo: Evaluar las características endoscópicas y patológicas del cáncer gástrico del Hospital Nacional Luis N. Sáenz entre 2008 y 2013. Materiales y métodos: Estudio observacional retrospectivo transversal. Se revisó los informes endoscópicos, de pacientes mayores a 30 años, se ingresó al estudio el diagnóstico histológico de adenocarcinoma gástrico, las variables patológicas como tipo histológico, presencia deH. pylori y de metaplasia intestinal e incompleta. Resultados: Se identificó 92 casos de adenocarcinoma gástrico. Prevalencia promedio 0,6%, prevalencia de 0,34% en 2009 y 0,82% en 2013, sexo masculino 62%, femenino 38%, edad menor de 55 años 16%, mayor a 76 años 42%; presentación endoscópica Borrmann III 57%, II 16,3%, IV 15%, V 7,6%, I 3,3%; presentación distal 8 veces más frecuente que la proximal, tipo histológico intestinal 75%, H. pylori presente en 50% casos, metaplasia intestinal en 40% de casos de cáncer gástrico. Conclusiones: Se encontró una alta prevalencia de cáncer gástrico. Frecuente en sexo masculino y en mayores de 76 años, presentación endoscópica más frecuente fue Borrmann III, la presencia de H. pylori y metaplasia intestinal incompleta asociada a cáncer tipo intestinal

ABSTRACT Objective: The endoscopic and pathological characteristics of gastric cancer in Luis N. Sáenz National Hospital between 2008 and 2013. Materials and methods: retrospective cross-sectional observational study. We reviewed the endoscopic reports of patients older than 30 years, we studied the histological diagnosis of gastric adenocarcinoma, pathological variables such as histological type, presence of H. pylori and complete and incomplete intestinal metaplasia. Results: 92 cases of gastric adenocarcinoma were identified. Average prevalence 0.6%, 0.34% in 2009 and 0.82% in 2013; 62% male, 38% female, age less than 55 years 16%, greater than 76 years 42%; endoscopic presentation Borrmann III 57%, II 16.3%, IV 15%, V 7.6%, I 3.3%; 8 times most frequent presentations distal the proximal v, 75% histologic intestinal type, H. pylori in 50% cases, intestinal metaplasia in 40% of cases of gastric cancer. Conclusion: We found high prevalence of gastric cancer. Common in males, and in people over 76, more frequent endoscopic presentation was Borrmann III, the presence of H. pylori and incomplete intestinal metaplasia associated with intestinal cancer type.

Frecuencia y perfil clínico de cáncer de vesícula biliar en pacientes colecistectomizados en 3 hospitales referenciales de Chiclayo entre 2011 y 2015 / The frequency and clinical profile of gallbladder cancer in patients undergoing cholecystectomy in 3 reference hospitals in Chiclayo between 2011-2015

Objetivos: Describir la frecuencia y perfil clínico de cáncer de vesícula biliar en pacientes colecistectomizados en 3 hospitales referenciales en Chiclayo entre 2011-2015. Materiales y métodos: Estudio descriptivo transversal retrospectivo. El estudio está dividido en 2 fases, la primera consistió en contabilizar el número total de informes de patología de vesícula biliar y seleccionar los casos positivos para cáncer; la segunda fase consistió en recolectar datos de las historias clínicas de los pacientes positivos para cáncer. Resultados: De 5720 reportes de anatomía patológica de vesícula biliar, 58 (1,01%) fueron positivas para neoplasia vesicular. 42 casos (72,4%) fueron mujeres y solo 16 (27,6%) fueron hombres. El síntoma más frecuente fue el dolor abdominal con 41 casos (70,7%). 18 pacientes (31%) refirieron otra sintomatología, la hiporexia fue la más frecuente con 8 casos (13,8%). 41 casos (70,7%) presentaron cálculos vesiculares. El tipo de cáncer que predomino fue el adenocarcinoma con 48 casos (82,8%) seguido por el carcinoma mucinoso con 3 casos (5,2%). Conclusiones: En el departamento de Lambayeque la frecuencia de cáncer de vesícula biliar fue de 1,01% con predominancia en el sexo femenino y sexta década de la vida, siendo el Adenocarcinoma, el tipo más común. Así mismo, los pacientes presentaron con mayor frecuencia dolor abdominal e ictericia

ABSTRACT Objectives: To describe the frequency and clinical profile of gallbladder cancer in patients undergoing cholecystectomy in 3 reference hospitals in Chiclayo between 2011-2015. Materials and methods: A retrospective cross-sectional study. The study is divided into 2 phases, the first was to count the total number of reports of gallbladder pathology and select positive cases for cancer; the second phase was to collect data from the medical records of patients positive for cancer. Results: From 5720 pathology reports gallbladder, 58 (1.01%) were positive for vesicular neoplasia. 42 cases (72.4%) were women and only 16 (27.6%) were men. The most common symptom was abdominal pain in 41 cases (70.7%). 18 patients (31%) reported other symptoms, the hyporexia was the most frequent with 8 cases (13.8%). 41 cases (70.7%) had gallstone. The predominant type of cancer was adenocarcinoma in 48 cases (82.8%) followed by mucinous carcinoma in 3 cases (5.2%). Conclusions: In the department of Lambayeque frequency of gallbladder cancer was 1.01% with predominance in females and sixth decade of life, being Adenocarcinoma, the most common type. Likewise, patients had more frequent abdominal pain and jaundice

Epidemiological aspects of endoscopic resections of colorectal polyps in patients at an endoscopy training center in the Santos region, Brasil / Aspectos epidemiológicos de las resecciones endoscópicas de los pólipos colo-rectales en un centro de entrenamiento de endoscopía en la región de Santos, Brasil

Introduction: Colorectal polyps are structures that project from the surface of the mucosal layer of the large intestine. They are classified as neoplastic or non-neoplastic. Early detection of pre-neoplastic lesions is important for preventing colorectal cancer. These can be resected so as to decrease the morbidity and mortality rates. Colonoscopy is the gold-standard procedure for diagnosing and resecting precursor lesions. Objective: To evaluate the epidemiological, endoscopic and histological aspects of endoscopic resection of lesions of the colon and rectum at a training center. Materials and method: A search was conducted in the database of our institution covering the period from January 2011 to July 2014. Cases that underwent endoscopic resection of polyps and/or colorectal lesions were selection. The following variables were defined: general data on the patients (age, gender and indication from the examination) and data on the polypoid lesion (number, histological type and topographic distribution). Results: 678 lesions were identified in 456 examinations. Regarding sex, 242 (53.1%) were female and 214 (46.9%) were male. The mean age was 64.54 years, with extremes of 5 and 94 years. The most frequent locations were the rectum (21%) and sigmoid (20%). Histologically, 34.7% were hyperplastic polyps and 58.9% were adenomatous polyps, of which 74.1% were tubular, 10.6% tubulovillous, 2% villous and 13% indeterminate; and 1.7% were adenocarcinomas. In 65.4% of the cases, the examination showed that only one polyps was present, while 34.6% had two or more lesions. Conclusion: In our clinic, with a mean of 250 examinations/month, the parameters evaluated were compatible with the results reported in the literature.

Introducción: Los pólipos colorrectales son estructuras que se proyectan en la superficie de la capa mucosa del intestino grueso. Son clasificados en neoplásicos y no neoplásicos. La detección precoz de lesiones preneoplásicas es relevante en la prevención del cáncer colorrectal. Pueden ser resecados y reducir los índices de morbimortalidad. La colonoscopia es el patrón de oro para el diagnóstico y resección de lesiones precursoras. Objetivo: Evaluar aspectos epidemiológicos, endoscópicos e histológicos relacionados a las resecciones endoscópicas de lesiones de colon y recto en un centro de entrenamiento. Matariales y métodos: Fue realizada una búsqueda en la base de datos de nuestra institución durante el período de enero de 2011 a julio de 2014. Se seleccionaron aquellos sometidos a las resecciones endoscópicas de pólipos y/o lesiones colorrectales. Las siguientes variables fueron definidas: datos generales de los pacientes (edad género e indicación del examen) y datos de la lesión polipoidea (número, tipo histológico, distribución topográfica). Resultados: Fueron identificadas 678 lesiones en 456 exámenes. Con relación al sexo, 242 (53,1 %) eran del género femenino y 214 (46,9 %) masculino. El promedio de edad fue de 64,54 años, con extremos de 5 y 94 años. La ubicación más frecuente fue en el recto (21 %) y sigmoide (20 %). Histológicamente, 34,7% eran pólipos hiperplásicos y 58,9% adenomatosos, siendo 74,1% tubulares, 10,6% tubulovellosos, 2% vellosos y 13% indeterminados y, 1,7% correspondieron a adenocarcinomas. En el 65,4% de los casos existía solamente un pólipo al hacer el examen, 34,6% presentaban dos o más lesiones. Conclusión: En nuestro trabajo, con un promedio de 250 exámenes/mes, los parámetros evaluados fueron compatibles a los resultados encontrados en la literatura.

Trends in lung cancer incidence in Lebanon by gender and histological type over the period 2005-2008

Introduction: Lung cancer incidence rates, overall and by histologic subtypes, vary substantially by gender and smoking. This study's aim was to review data regarding trends in the number of cases of different lung-cancer histologies and relate these to smoking habits by gender in Lebanon

Materials and methods: Lung cancer data using ICD-0, 3rd edition, from the Lebanese National Cancer Registry from 2005 to 2008 were stratified by gender for histology type for patients aged over 18 years. Results: Lung cancer cases among males were 2.5 times higher than those in females. The most common lung cancer histology type for males and females was adenocarcinoma for all observed years. The proportion of squamous cell carcinoma in incident cases was significantly higher in males than in females for the total period from 2005 to 2008, P = 0.032, but not in individual years. The ratio of adenocarcinoma to squamous cell carcinoma in incident cases between 2005 and 2008 was 2:45 for males and 3:15 for females

Conclusion: Lung cancer histology in Lebanon is following a pattern similar to that found in most countries of North America and in Europe, where adenocarcinoma is the most prevalent subtype among both males and females

Morbilidad y mortalidad en 1028 duodenopancreatectomías cefálicas / Morbidity and mortality afer 1028 cephalic duodenopancreatectomies

Antecedentes: en las últmas décadas se han extendido las indicaciones de duodenopancreatectomía cefálica (DPC). Sin embargo, las series con más de 1000 DPC provienen de unos pocos centros de los Estados Unidos y Europa y ninguna de Latinoamérica. Objetivo: evaluar la morbilidad y mortalidad de 1028 DPC consecutivas realizadas por un mismo equipo quirúrgico. Material y métodos: se analizaron los datos de una base prospectiva de 1028 DPC consecutivas. Se determinaron los datos demográficos, la indicación de la cirugía, el intervalo de tempo entre el inicio de los síntomas y la primera consulta, la clasificación de la American Society of Anesthesiologistis (ASA), el tipo de técnica quirúrgica, el tempo operatorio, la colocación de drenaje biliar previo, el diagnóstico anatomopatológico, la morbilidad y la mortalidad. Se compararon la morbilidad y la mortalidad de la DPC en dos centros de salud. Resultados: las 1028 DPC se realizaron en un período comprendido entre julio de 1994 y diciembre de 2014. La edad promedio fue 59,6 años y 565 pacientes (55%) fueron de sexo masculino. Las indicaciones más frecuentes fueron tumor de páncreas (n=262) y tumor de papila (n=249). En 670 casos se diagnosticó patología maligna. El promedio de tempo entre el inicio de los síntomas y la primera consulta fue de 71 días (rango 10 a 123 días). En 461 pacientes (44%) se drenó la vía biliar antes de la cirugía. En 399 pacientes (35,3%) se registraron una o varias complicaciones. La fistula pancreática (21%) y el vaciamiento gástrico retardado (11%) fueron las complicaciones más frecuentes. Se registró una mortalidad del 3,1% (32 pacientes). Todas las DPC fueron realizadas en dos centros, uno público (n=642) y el otro privado (n=386). Los pacientes operados en el centro público tuvieron en forma signi-ficativa mayor morbilidad (46% vs. 27%, p> 0,001) y mortalidad (4% vs. 1,5%, p< 0,001). Conclusión: la DPC realizada por cirujanos de alto volumen en cirugía pancreática tene elevada morbilidad, pero baja mortalidad. A pesar de los buenos resultados globales, la morbimortalidad de la DPC en un centro público fue significativamente mayor que la del centro privado.

Background: in recent decades the indicatons for pancreaticoduodenectomy (PD) has been extended. However, series of patentis with more than 1000 PD come from a few center in the USA and Europe and none from Latin America. Objective: to evaluate the morbidity and mortality of 1028 consecutive PD performed by the same surgical team. Material and methods: we analyzed data from a prospective data base of 1028 consecutive PD. The demographic data, the indicaton of surgery, the tme interval between the onset of symptoms and the frst consultaton, the classificaton of the ASA, the type of surgical technique, operative tme, placement of biliary drainage, the anatomopathological diagnosis, the morbidity and the mortality was determined. We compared the morbidity and mortality of the PD at two diferent health centers Resultis: the 1028 PD were performed in a period between July 1994 and December 2014. The mean age was 59.6 years and 565 (55%) were male. The most frequent indicatons were pancreatic tumor (n = 262) and ampullary tumor (n = 249). Malignant tumors were found in 670 patentis. The average tme between onset of symptoms and the frst consultaton was 71 days (range 10-123 days). Preoperative biliary drainage were performed in 461 (44%) patentis. Morbility was 35.3% (399 patentis). Pancreatic fistula (21%) and delayed gastric emptying (11%) were the most frequent complicatons. All PD were performed at two centers, one public (n = 642) and the other private (n = 386). Patentis operated at the private center had significantly lower morbidity (27% vs 46%, p <0.001) and mortality (1.5% vs 4%, p <0.001) Conclusion: the DPC performed by high-volume surgeons in pancreatic surgery has high morbility, but low mortality. Despite the overall good performance, morbidity and mortality of the DPC in a public center was significantly higher than the private center.

Predictores clínicos y funcionales del riesgo de cáncer pulmonar en el seguimiento de una cohorte de adultos fumadores / Risk factors for the development of lung cancer in a cohort of adult smokers

Background: Identifying risk factors for lung cancer in the population could improve the cost-effectiveness of early detection programs using thoracic computed tomography (CT). Aim: To examine the risk factors of lung cancer in a cohort of adult smokers. Patients and Methods: An annual clinical and respiratory functional assessment, chest computed tomography for three years and clinical follow up for five years was carried out in 270 patients aged 65 ± 9 years, 55% males, active or former smokers of 10 or more pack-years. Results: Thirty seven percent of patients were active smokers, consuming 37 ± 26 packs/year, 85% had comorbidities, especially chronic obstructive pulmonary disease (COPD) (66%), hypertension (48%), diabetes (22%) and dyslipidemia (42%). Thirteen percent of patients had family history of lung cancer. Twenty-one cases of lung cancer were detected in the five years follow up, especially squamous cell carcinoma and adenocarcinoma. In the univariate analysis, the main risk factors for lung cancer identified were an age older than 60 years, history of COPD, family history of lung cancer, active smoking, tobacco consumption more than 30 pack/year and lung hyperinflation. In multivariate analysis, the three independent risk factors for lung cancer were a family history of lung cancer, active smoking and the number of packs per year of tobacco consumption. Conclusions: The identification of risk groups probably will improve the performance of programs for early detection of lung cancer.

Epidemiological profile and prognostic factors in patients with lung cancer / Perfil epidemiológico e fatores prognósticos em pacientes com câncer de pulmão

SUMMARY Objective: To describe the epidemiological profile of patients with lung cancer treated at a public tertiary referral hospital specializing in oncology, and to explore variables that may be related to the overall survival (OS) of these patients. Method: Data from the medical records of all patients with invasive lung cancer consecutively seen at the Oncology Department of Hospital Estadual Mário Covas between August 2008 and December 2013 were extracted. The information obtained was submitted to statistical analysis. Results: Of the total 210 patients, 39 were excluded from analysis due to lack of information in the medical record. The most common histological type was adenocarcinoma, representing 39.41% of the sample, followed by squamous cell carcinoma with 25.29% and small-cell carcinoma with 13.53%. Other histological types were responsible for the remaining 21.76%. There was a statistically significant association between Karnofsky performance status (KPS) ≤ 70%, palliative chemotherapy lines performed and stage at diagnosis, and OS. Additionally, administration of target therapy to patients with EGFR mutation was associated with significantly better overall survival. However, analysis of laboratory variables (hemoglobin, albumin and LDH) as possible prognostic factors for survival showed no statistically significant relationship. Among patients with stage III and IV, the median OS was 10.1 months. Conclusion: The risk factors for shorter OS were KPS score ≤ 70%, less than two lines of palliative chemotherapy, and stage III and IV at diagnosis. The implementation of CT screening for risk patients may allow earlier diagnosis of cases and improve these results.

RESUMO Objetivo: traçar o perfil epidemiológico de pacientes com câncer de pulmão atendidos em hospital público terciário de referência em oncologia e explorar variáveis que possam estar relacionadas com a sobrevida global (SG) desses pacientes. Método: foram extraídos dados dos prontuários de todos os pacientes com câncer de pulmão invasivo, entre agosto de 2008 e dezembro de 2013, atendidos consecutivamente no Serviço de Oncologia do Hospital Estadual Mário Covas. As informações obtidas foram submetidas à análise estatística. Resultados: do total de 210 pacientes, 39 foram excluídos da análise pela ausência de informações no prontuário. O tipo histológico mais frequente foi o adenocarcinoma, representando 39,41% da amostra, seguido do carcinoma espinocelular com 25,29% e de pequenas células com 13,53%. Outros tipos histológicos foram responsáveis pelos 21,76% restantes. Houve associação com significância estatística entre KPS ≤ 70%, linhas de quimioterapia paliativa realizadas e estágio ao diagnóstico com SG. A administração de terapia-alvo direcionada para pacientes com mutação do EGFR foi significativamente associada à melhor SG. A análise das variáveis laboratoriais (hemoglobina, albumina e desidrogenase lática – DHL) como possíveis fatores prognósticos de sobrevida não mostrou relação estatisticamente significativa. Entre os pacientes em estágio III e IV, a SG mediana foi de 10,1 meses. Conclusão: os fatores de risco para menor SG foram KPS ≤ 70%, menos de duas linhas de quimioterapia paliativa e estágios III e IV ao diagnóstico. A implementação do rastreamento tomográfico de pacientes de risco poderá permitir o diagnóstico mais precoce e a melhora desses resultados.

Comportamiento clínico, epidemiológico, endoscópico e histológico del cáncer gástrico de tipo epitelial / Clinical, epidemiological, endoscopic and histological behavior of epithelial gastric cancer

INTRODUCCIÓN: el cáncer gástrico constituye un grave problema de salud mundial por ser una de las enfermedades de más difícil control. OBJETIVO: describir las principales características clínicas, epidemiológicas, endoscópicas e histológicas del cáncer gástrico de tipo epitelial. MÉTODOS: estudio observacional de casos y controles, en el Instituto de Gastroenterología, entre septiembre de 2012 y agosto de 2014. Se incluyeron 27 casos y 54 controles. RESULTADOS: predominaron las mujeres (59,3 %, n= 27), fue más frecuente entre 70 a 79 años, edad media de 63,9 años. La epigastralgia fue el síntoma más frecuente en ambos grupos [85,2 % (casos) vs 81,5 % (controles)], su asociación con náuseas, vómitos, astenia, anorexia y pérdida de peso fue más frecuente en los casos, se mostró diferencias estadísticamente significativas (P= 0,008, IC= 1,39-25,31). El signo físico más frecuente fue la palidez cutáneo-mucosa. Fueron más frecuentes las lesiones mayores de 2 cm, en los dos tercios distales del estómago, así como el tipo III (clasificación de Paris). El carcinoma de células en anillo de sello predominó (48,1 %). CONCLUSIONES: la epigastralgia asociada a la astenia, la pérdida de peso y la anorexia constituyen la sintomatología clínica más frecuente en los pacientes con cáncer gástrico de tipo epitelial. El tipo histológico más frecuente fue el carcinoma de células en anillo de sello.

INTRODUCTION: Gastric cancer is a serious health problem due to the complexity of its control. OBJECTIVE: Describe the main clinical, epidemiological, endoscopic and histological characteristics of epithelial gastric cancer. METHODS: An observational case-control study was conducted at the Institute of Gastroenterology from September 2012 to August 2014. The study sample consisted of 27 cases and 54 controls. RESULTS: There was a predominance of the female gender (59.3 %, n= 27) and the 70-79 age group, with a mean age of 63.9 years. Epigastralgia was the most common symptom in both groups [85.2 % (cases) vs. 81.5 % (controls)]. Its association with nausea, vomiting, asthenia, anorexia and weight loss was more frequent in cases, with statistically significant differences (P= 0.008, CI= 1.39-25.31). The most common physical sign was skin and mucous pallor. The most frequent lesions were those larger than 2 cm, located in the two distal thirds of the stomach, and type III of the Paris classification. Signet ring cell carcinoma predominated (48.1 %). CONCLUSIONS: Epigastralgia associated to asthenia, weight loss and anorexia are the most common clinical symptoms in patients with epithelial gastric cancer. The most frequent histological type is signet ring cell carcinoma.